retroperitoneal hemorrhage
Introduction
Introduction to retroperitoneal space bleeding HemorrhageinRetroperitonealSpace is one of the complications of severe abdominal injury. It is easily misdiagnosed because it is often covered by intra-abdominal organ damage or other parts (such as brain, chest, spine, limbs and pelvis). It is more difficult, and serious people can be life-threatening. The reported mortality rate is as high as 42%. basic knowledge The proportion of illness: 0.002% Susceptible people: no special people Mode of infection: non-infectious Complications: shock, intestinal obstruction, acute renal failure
Cause
Cause of retroperitoneal hemorrhage
Retroperitoneal hemorrhage is common in complex abdominal injury, accounting for 2/3 of retroperitoneal hemorrhage, including:
Retroperitoneal space with rupture of liver, spleen, kidney, adrenal gland, pancreaticoduodenal and blood vessels; pelvic fracture with rectal, bladder and ureteral injury; abdominal blunt contusion, pelvic fracture, direct or indirect damage to the peritoneum After the blood vessels and their branches.
Penetration injury of bullets or shrapnel; sharp knife or sharp stab wound; puncture wound of epiphyseal after fracture, retroperitoneal hemorrhage can also be seen in pathological destruction of retroperitoneal organ, including: a. hemorrhagic necrotizing pancreatitis; b. Hemorrhagic diseases, such as hemophilia, leukemia, hypersplenism, etc. caused by various causes of coagulation hypofunction can cause peritoneal bleeding; c. anticoagulant therapy caused by low coagulation; d. Caused by surgery; e. Others: there are retroperitoneal tumors, hemangioma, nodular polyarteritis and spontaneous retroperitoneal vascular rupture (abdominal stroke).
Because the retroperitoneal is loose tissue, the bleeding episodes are mostly sudden, the hematoma quickly infiltrates and forms a huge hematoma. The systemic reaction may have blood pressure drop, even shock, and the retroperitoneal tissue is compressed. The hematoma can be diffused along the posterior wall of the abdomen and the mesentery. Can be penetrated into the abdominal cavity, such as bleeding occurs slowly, or stop by itself, can form a wrapped or localized hematoma, and finally, the center of liquefaction or fibrosis, computerized, small hematoma can be absorbed.
Prevention
Prevention of retroperitoneal bleeding
Depending on the speed, quantity, cause and early detection of the bleeding, the mortality of aortic rupture is very high. The peritoneal hemorrhage after pregnancy is seriously harmful to both mother and child. The prognosis of bleeding caused by other causes is better.
Complication
Retroperitoneal hemorrhage complications Complications, shock intestinal obstruction, acute renal failure
Retroperitoneal hemorrhage can occur suddenly, such as arterial hemorrhage, can form a hematoma to cause peritoneal tissue after compression, diffuse between the mesentery, enter the peritoneal space of the pelvis or enter the peritoneal cavity, bleeding occurs slowly, and some spontaneously stop can be absorbed If the blood continues to stay in the posterior peritoneum, it can be mechanically formed into fibrous mass, or even calcified, and the blood contains nutrients, so the risk of infection is great.
The comorbidities include hemorrhagic shock, paralytic ileus, thrombophlebitis of the lower extremities, and acute renal failure.
Symptom
Symptoms of retroperitoneal space bleeding Common symptoms Intestinal palsy, low blood pressure, abdominal muscle tension, peritoneal irritation, abdominal pain, nausea, constipation, bowel
The main symptoms are abdominal pain. Abdominal pain is the earliest and most common symptom. The degree is different. It can be limited or diffused. The position can be in the abdomen, side abdomen, waist or even the back or acetabulum. Sometimes the squat can relieve, other Common symptoms are nausea and vomiting, constipation or mild diarrhea, weakened bowel, abdominal distension and paralytic ileus, etc., severe cases may be associated with hemorrhagic shock and severe anemia, blood loss and stimulation of the posterior peritoneal nerve may cause sweating, palpitations, low Blood pressure, syncope and even shock, some patients have a short-term fever, with the development of the disease can occur paralytic ileus, hematoma compression of the mesenteric blood vessels, can cause local intestinal necrosis, hematoma compression nerves, lower extremity neuropathic pain, numbness Even dysfunction, hematoma can affect the celiac plexus, causing autonomic dysfunction, gastrointestinal and urinary tract peristalsis and excretory dysfunction.
Abdominal examination has local tenderness, sometimes in the abdomen, side abdomen or waist can touch the mass or full, generally no or only mild abdominal muscle tension, when the hematoma breaks into the abdominal cavity, or accompanied by intra-abdominal organ damage, may be associated with intestinal paralysis If it is a serious arterial hemorrhage, the mass can be swollen rapidly, and even pulsation, the skin near the bleeding, such as the waist, the abdominal wall and the scrotum, ecchymosis, hematoma breaks into the abdominal cavity, often shock and peritoneal irritation, occasional report stocks Nervous involvement, a special manifestation of quadriceps weakness and loss of knee reflex.
Examine
Examination of retroperitoneal hemorrhage
1. Ordinary X-ray examination or double contrast angiography can reveal some lesions that can cause post-peritoneal hemorrhage, such as fractures, abdominal aortic aneurysm, urinary tract or gastrointestinal disease, unclear outline of the psoas muscle and partial interruption of the margin.
2. B-mode ultrasound can detect hematoma and abdominal aortic aneurysm, but the identification of hematoma and abscess and other fluid accumulation (such as urine) often have certain difficulties.
3. CT examination can clearly show the relationship between hemorrhagic hematoma and other tissues, and the attenuation value increases when the scan is enhanced, which is evidence of active bleeding.
4. Angiography and isotope scans can indicate the location of the bleeding.
5. B-mode ultrasound or CT-guided puncture aspiration to confirm the diagnosis.
6. Laboratory tests: initial white blood cells are slightly higher or normal, red blood cells and hemoglobin can be reduced, white blood cells are significantly increased in the late stage, neutrophils are increased, serum amylase and urinary amylase are increased in pancreatic injury, and renal contusion and laceration can be Hematuria proteinuria occurs.
Diagnosis
Diagnosis and diagnosis of retroperitoneal space hemorrhage
The rate of misdiagnosis of retroperitoneal hemorrhage is higher, which is due to insufficient understanding of intra-abdominal organ injury and post-peritoneal hemorrhage. Only attention is paid to the diagnosis of spleen rupture or pelvic fracture, while the retroperitoneal injury is neglected. The diagnosis is mainly based on abdominal trauma (part, The degree of violence and other medical history) and typical symptoms and signs, combined with B-mode ultrasound, abdominal CT and X-ray film, if necessary, can be used for excretory pyelography or arteriography.
The clinical manifestation depends on the speed, quantity, cause, location of the bleeding and the organ involved. For example, the amount of bleeding is limited, and the range is limited. It is difficult to have a typical performance of fixation. Especially in the case of complicated composite injury, the symptoms are more easily concealed.
Most patients with this disease progress rapidly, symptoms appear within hours or days, and a few clinical processes are concealed, and anemia and masses appear later.
Need to be differentiated from retroperitoneal hematoma, intra-abdominal hemorrhage.
